Toe Pain Research Articles

Association of pain with falls and fractures among middle-aged Korean community-dwelling adults.

The relationship between pain and falls remains controversial. Therefore, this study explored the associations between pain and fall-related outcomes in 5,340 middle-aged (45-65 years) adults residing in the communities in Korea. Pain was defined as pain at any location, pain-related activity restriction (PAR), and persistent pain. The outcome measures included fall injuries, recurrent falls, injurious falls, and fall-related hip fractures. A multivariate logistic regression model was used to examine the relationship between pain and fall outcome. Among the study participants, 54.0% reported having experienced pain. During a follow-up period of up to 14 years, those who reported pain and PAR at baseline exhibited a positive association with the occurrence of fall injury (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.27-2.53) and injurious falls (OR 1.72, 95% CI 1.20-2.48) but not with recurrent falls (OR 1.90, 95% CI 0.80-4.54). We also observed a positive association between persistent pain and the risk of fall injury (OR 1.41, 95% CI 1.13-1.91), whereas no consistent conclusions were drawn regarding the risk of recurrent falls and injurious falls. We also did not identify any correlation between pain and hip fractures resulting from falls. In conclusion, our findings of the positive correlations of pain and PAR at baseline with fall injuries and injurious falls but not recurrent falls during follow-up suggest that public health initiatives should prioritize pain screening, especially for participants reporting ankle and toe pain, and implement suitable interventions to mitigate the risk of falls and the associated adverse outcomes among middle-aged adults.

Congenital Generalized Lipodystrophy in a Division 1 Female Sprinter.

A 21-year-old African American Division 1 female sprinter presented with 3-weeks history of right great toe and forefoot pain, fatigue, and a 30-day continuous menstrual cycle despite implanted etonogestrel (Nexplanon) inserted 3 years prior. An magnetic resonance imagine (MRI) identified likely stress fracture of the second metatarsal base with a diffusely low T1 signal indicating hyperactive red marrow. Due to persistent pain, a follow-up MRI was ordered 6 months later and indicated serous atrophy of the bone marrow, prompting a further metabolic workup notable for triglycerides exceeding 4000 mg/dL and a hemoglobin A1c of 10.9%. This case highlights the manifestation of a rare congenital lipodystrophy that initially presented as a relatively classic stress fracture and metrorrhagia in a female athlete.

Does Hallux Valgus Correction with Chevron-Akin Osteotomies Reduce the Length of the First Ray

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Patients who undergo a successful surgical correction of hallux valgus have relieved toe pain and improvements in foot appearance. Prior studies have shown hallux valgus correction using a distal Chevron osteotomy with a concomitant Akin osteotomy has the potential to reduce forefoot width. There are no studies evaluating if similar changes occur in the length of the foot. The objective of this study is to check if similar reduction occurs in the patient's foot length. Methods: The operating room schedule of Dr. Panchbhavi and Dr. Chen were reviewed for Chevron/Akin Osteotomies from 2017-2022. Patient charts were excluded for contaminant operations of the foot. The preoperative and postoperative radiographs were then evaluated by one medical student with oversight from a Board-Certified Foot and Ankle Orthopedic Surgeon. The Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Metatarsal Span (MS), first/second ray of the foot, and difference between first and second ray were all be measured based on predetermined methods. All variables were analyzed utilizing an unpaired t-test. Results: In total 12 Chevron/Akin patients met the criteria. The results indicated that with chevron/akin osteotomy measurements of the foot were affected in HVA, IMA, MS, and length of first ray relative to second ray. The average results for each of these values were a decrease of 9.2 degrees (SD 4.32), 7.93 degrees (SD 4.33), 11.63mm (SD 2.26) respectively. For results of change in difference of first and second ray, average results for those who underwent Chevron/Akin Osteotomy was -2.23mm (SD 2.23, p = 0.0281). Both changes to MS and length were statistically significant (p < 0.05). Conclusion: Our results were consistent with existing evidence, Chevron with contaminant Akin Osteotomy will produce statistically significant changes in width of the foot; however, also a significant decrease in the length of the first ray relative to the second ray. All measurements were done utilizing PACS software and can be reliably used in clinics as a clinical tool to gauge post- operative outcomes alongside providing adequate patient education on the potential changes in foot length and width.

Previously unreported X-ray findings associated with distal toe pain in children.

While children undergo skeletal maturation, it is difficult to distinguish between normal variants and abnormalities of the epiphysis and acrophysis on radiological images. Abnormalities in the epiphysis and acrophysis of the toe phalanx have not been reported yet. Here, we describe a series of abnormalities in the epiphysis and acrophysis of the fourth and fifth toe phalanges, including an investigation of their pathogenesis. We evaluated patients suspected of having bone tumors at a local orthopedic clinic because of abnormal findings of the toe phalanx between the distal and middle phalanx on plain radiographs. The site of the lesion, duration of pain until the hospital visit, history of trauma and sports, treatment, and clinical course were investigated. A total of seven patients (five boys and two girls) with a mean age of 10 years (range 9-16) were included. In all cases, a circular erosive radiolucent image was present between the distal and middle phalanx. In two cases, the fourth toe was affected, and in five cases, the fifth toe was affected. Six patients showed improvements with conservative treatment using shoe insoles. In one case, surgical treatment was performed for persistent pain. Histological examination of the fibrous tissue collected from the circular erosive radiolucent area revealed normal bone and slightly degenerated hyaline cartilage. This is the first report on the abnormalities of the epiphysis and acrophysis of the toe phalanx, which is termed as Shintaniwakino disease. A better understanding of this disease may aid in the avoidance of unnecessary treatment.

A Rural Obstetrician with Acute Severe Foot Pain: Could it be a Scorpion Sting?

ABSTRACT Scorpion stings, a potentially life-threatening emergency, are under-reported in Nigeria. A sudden initially unexplained, severe excruciating, right toe pain with minimal swelling in a rural-dwelling obstetrician was due to a sting by an unknown species of scorpion lodged in the victim’s shoe. He was managed by supportive treatment with digital block using plain lignocaine, intravenous hydrocortisone, analgesics, tetanus prophylaxis, and close monitoring with a good outcome. Scorpion sting can occur in the rural-dwelling healthcare worker despite their knowledge of preventive measures. The low index of suspicion, coupled with fatigue/burnout from work overload, can be risk factors for stings. A sting is an important differential diagnosis of acute severe foot pain, especially in rural settings where animal bites and stings are common. There is poor scorpion species characterization among healthcare workers. Reduction of incidences of stings will require consistent application of preventive measures.

Ayurvedic management of Vatarakta with special reference to Gout: A Case Study

Vatarakta is a disease explained in Ayurveda involving Vata Dosha imbalance affecting Rakta Dhatu, where the Vayu gets aggravated due to long distance rides on animals like elephants, camels, horses, and on the other hand Rakta or blood gets vitiated by the consumption of Lavana, Amla, Katu, Kshara etc. The Vata, whose passages are blocked by Rakta further undergoes vitiation and further contaminates the Rakta or blood. The blood vitiated by Vayu later burns the whole blood in the body and later gravitates towards thefoot. This vicious amalgamation of vitiated Vata and Rakta is called Vatarakta. Vatarakta can even be correlated to Gout on the basis of etiopathology. A 45 years old female patient approached the OPD with the chief complaints of: Right great toe pain, swelling along with discoloration. Right ankle joint pain, swelling along with burning sensation of b/l sole. Right wrist joint pain along with difficulty in movements & Generalised weakness was also seen. All the above complains were since 4 months. The patient was given completely Ayurvedic medicines such as Kaishor guggul, Amrutadi guggul, Sanshamani Vati, Guduchi kwath for oral consumption & Pinda Tail (Sukhoshna) for local application & sarvanganadisweda with dashmool kwath for 2 months, follow up was taken on every week for 2 months. The results were remarkably seen. Hence this study was taken to prove that Ayurvedic management has remarkable results in Vatarakta (Gout).

Hallux deformity influence - quality of life

Background: Hallux valgus is a very common deformity of the big toe and can befamilial or acquired. Knowledge of risk factors of hallux valgus is important in order to prevent or minimize progression of this deformity, since a surgical intervention is the only treatment to correct this deformity. The objective of this study was to determine the risk factors of hallux valgus deformity and the influence in quality of life Material and Methods: This was a cross-sectional study was conducted in Gadarif state, eastern Sudan from January to June 2021.Structured questionnaires were used to collect data from participants. An informed consent was obtained before data collection. Results: A total of 59 subjects from Gadarif state with HA were enrolled in this study. The females were 32 (54.2%).The most common affected age group was > 35 years accounted 44 (74.6%).33 (55.9 %) of study subjects had normal body weight(statistically not significant p=0. 957).41(69.5%) subjects had a family history of HV (statistically significant p=0. 000). 20/32 (62.5%) female use high heelShoe.44 (74.6 %) subjects had a weakness hallux plantar flexion action and abduction(statistically significant p=0. 000). Conclusion: This study found the prevalence of HV increased with age and was higher in females. There was significant correlation between the family history and hallux deformity. Also the study observed significant association between the severity of hallux deformity and impairment of functions of hallux plantar muscles. There is a reduction in health in general and particularly in foot health with increasing severity pain of hallux deformity that appears to be associated with increase in age. Keywords: hallux valgus, female, male, big toe pain, family history, life quality, Gadarif state, Sudan

Soccer player with painful toe

An x-ray revealed the source of the toe nodule and the nail dystrophy.

The Utility of Ultrasound in the Evaluation of Traumatic Hallux Valgus.

Level V.

The Influence of Concomitant Hammertoe Correction on Postoperative Outcomes in Patients Undergoing Hallux Valgus Correction

Category:Bunion; Lesser ToesIntroduction/Purpose:Patients with hallux valgus often develop secondary hammertoe deformities of the lesser toes. Chronic lateral deviation of the hallux leads to proximal interphalangeal joint flexion contracture, metatarsophalangeal joint subluxation and ultimately a cross-toe deformity. Operative management of bunions with hammertoe is more extensive since both the primary bunion deformity and the secondary defect have to be corrected simultaneously; however, it is unclear whether simultaneous bunion and hammertoe correction affects patient outcomes. The objective of this study was to compare postoperative patient reported outcomes using the patient-reported outcome measure information system (PROMIS) scores and radiographic outcomes between patients who underwent isolated bunion deformity correction and patients who underwent operative repair of hallux valgus with concomitant hammertoe correction.Methods:This retrospective cohort study included patients over the age of 18 who were treated operatively by 1 of 7 fellowship-trained foot and ankle surgeons for hallux valgus. Those with clinically symptomatic hammertoes were also corrected at the surgeon's discretion. All patients had minimum 1-year postoperative PROMIS scores and minimum 3-month postoperative radiographs. Preoperative, final postoperative and change in PROMIS scores from 6 domains (physical function, pain interference, pain intensity, global physical and mental health, and depression) were compared between the isolated bunion and bunion with hammertoe correction groups. Radiographic measurements compared between cohorts included hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal-articular angle (DMAA), and Meary's angle. Radiographic parameters were measured on anteroposterior (AP) and lateral weightbearing radiographs. Statistical analysis utilized targeted minimum-loss estimation (TMLE) to control for confounders (age, gender, BMI).Results:A total of 221 patients (134 with isolated bunion correction, 87 with concomitant hammertoe correction) with an average of 19.2 months follow-up were included in this study. Demographically, patients in the concomitant hammertoe cohort were older than the isolated bunion group (58.5 vs 53.1, p<0.01) and had a higher BMI (24.8 vs 58.5, p<0.05). Both cohorts demonstrated improvement in all PROMIS domains except for global mental health and depression. The isolated bunion cohort had significantly better improvements in pain interference and pain intensity when compared to the concomitant hammertoe group (p<0.01, p<0.05 respectively) (Table 1). The isolated bunion cohort had lower postoperative pain interference scores (p<.01). Radiographically, the concomitant hammertoe group had a higher preoperative HVA than the isolated bunion group (30 vs 27.6, p<.05). There were no statistically significant differences between the two cohorts in postoperative radiographic parameters, in addition to the probability of achieving normal postoperative radiographic measures.Conclusion:Patients undergoing simultaneous bunion and hammertoe correction experienced worse postoperative outcomes measured by PROMIS pain interference, had significantly less improvement in PROMIS pain interference and pain intensity scores, and had more severe preoperative radiographic deformity when compared to those who underwent isolated bunion correction. The relationship between hallux valgus and hammertoe development should be considered when counseling patients for surgery. Patients with hallux valgus who show early signs of hammertoe formation such as second toe elevation or pain under the second metatarsal head may benefit from earlier bunion correction before the hammertoe progresses to the point of needing surgical management.

Understanding Patient Preference of Providers to Treat Foot and Ankle Disorders.

Objective: The purpose of this study is to evaluate patients' knowledge of the professional training between doctors of podiatric medicine (DPM) and orthopedic surgery doctors (MD or DO), patients' confidence in understanding these differences, and factors that are important to patients when selecting a provider.Design: A 28-question survey was administered to new patients who were referred to the foot and ankle service in an orthopedic department. Survey questions included data on patient demographics, patient opinion, and knowledge of differences between podiatrists and orthopedic surgeons.Setting: Patient surveys were administered at Froedtert Memorial Lutheran Hospital in Wauwatosa, Wisconsin USA and Mayo Clinic in Jacksonville, Florida USA.Participants: 186 patients completed the survey.Methods: Study population characteristics and survey results were analyzed with variance (ANOVA), Fisher's Exact test, binomial tests, and chi-square tests.Results: Of the 186 patients who completed the entire survey, 108 chose "orthopedic surgeon" as their provider of preference for any foot or ankle injury. Patients preferred an orthopedic surgeon over a DPM for ankle (65.7% vs. 9.6%, P<0.01) and knee injuries (86.0% vs. 5.0%, P<0.01), while they preferred a DPM for toe pain (29.4% vs. 42.2%, P<0.03). 80.8% of patients thought orthopaedic surgeons and podiatrists undergo the same professional training.Conclusions: Patients have poor understanding of the different provider training between a DPM and orthopedic surgeon. Patients showed a preference based on anatomic location with podiatrist favored for conditions affecting the toes. Those patients that demonstrate a higher level of knowledge of the specialties were more likely to prefer an orthopaedic surgeon. Other factors, such as physician interpersonal skills and provider availability, may be more important for patients than training backgrounds.

Point-of-care ultrasound for the evaluation of toe pain.

Point-of-care ultrasound for the evaluation of toe pain.

Cytologic Analysis of a Glomus Tumor in the Left Second Toe: Case Report

Abstract Introduction/Objective Glomus bodies reside in the stratum reticularis of the dermis as well as in visceral organs. Their functions involve temperature and blood pressure regulation. The incidence of glomus tumors is approximately 1.5%, occur more frequently in women, and generally manifest during the third to fifth decade of life. A majority of glomus tumors are diagnosed by biopsy and excision. At least 19 case reports exist in the literature where glomus tumors are diagnosed by fine-needle aspiration (FNA). We add to this growing literature by discussing a case report involving the cytologic findings of an FNA-diagnosed glomus tumor. Methods/Case Report A 66-year-old female presented with left second toe pain for 41 years but worsening in the past several months. Physical exam revealed 5/5 muscle strength in her toes without loss of sensation. There was no edema, erythema, nor ecchymosis. Pain was notably out of proportion when palpating her second nailbed. Magnetic resonance imaging (MRI) with contrast was performed revealing a 1.1 x 1.0 x 0.9 cm circumscribed, ovoid mass involving the dorsal aspect of the second toe distal phalanx along its dorsal margin (Figure 1). The patient underwent fine needle aspiration and biopsy. Cytologic findings included clusters of uniform cells with round to oval nuclei and scant cytoplasm. There was spindling of cells noted in some of the clusters. Cells were surrounded by thick wisps of magenta colored myxoid material reminiscent of a pleomorphic adenoma (Figure 2). Biopsy showed uniform cells surrounding capillaries. Immunohistochemistry performed on the biopsy showed that lesional cells were positive for alpha-smooth muscle actin (SMA). A diagnosis of glomus tumor was made. Amputation was performed with clear margins. Results (if a Case Study enter NA) NA Conclusion Glomus tumor is a rare tumor that is usually diagnosed on biopsy; however, it has distinct cytologic features that can aid in its diagnosis on fine needle aspirations.

Evaluation of Healing Potential in Diabetic Foot Ulcer With Pedal Acceleration Time

Predicting wound healing in diabetic patients is challenging owing to the presence of incompressible arteries. Recently, it has been shown that patients with diabetes mellitus are more likely to have calcification of the pedal arteries. The calcification can lead to spuriously high toe pressures, leading to a false assurance that the patient's ulcer will heal. Another limitation of toe pressures is that they cannot be measured in patients with toe amputations or painful toe ulcers. We studied the pedal acceleration time (PAT) as a predictive tool for healing potential. We identified 19 patients with diabetic foot ulcers. All 19 patients had undergone duplex ultrasound with a GE logic E9 linear probe scanner and high-resolution scanner (GE Healthcare, Chicago, Ill). Patients with aortoiliac occlusive disease were excluded. The imaged pedal arteries included the arcuate, lateral plantar, medial plantar, deep plantar, and dorsal metatarsal arteries. Patients with a PAT of <180 ms were assigned to best medical therapy and wound care and given a 4- to 6-week follow-up appointment for close monitoring. Patients with a PAT of >180 ms were considered for endovascular or surgical revascularization with a 4-week follow-up visit to document clinical progress and the postprocedure PAT. Nineteen patients were enrolled in the present study. Of the 19 patients, 11 were treated conservatively because of a PAT of <180 ms. After 4 to 6 weeks of follow-up, the ulcers of 10 of the 11 patients had healed. One patient had not completely healed and osteomyelitis of the great toe was diagnosed. Eight patients had had a PAT of >180 ms and were assigned to the intervention group. Two of these patients had undergone surgical bypass and their ulcers healed, and six had undergone endovascular intervention. Of the latter six patients, one had died of an unrelated cause. The ulcers of the remaining five patients had healed after endovascular intervention. The PAT can predict the healing potential of diabetic foot ulcers.

Five-year follow-up of endoscopic resection of symptomatic os trigonum: a prospective interventional cohort study of a possible cause of ankle and big toe pain

Background: The authors aimed to evaluate the functional outcomes of endoscopic resection and debridement of symptomatic os trigonum and associated inflammatory changes including the flexor hallucis longus (FHL) pathologies. Methods: A prospective interventional study was conducted including 28 patients with 32 symptomatic os trigonum in the period from January 2010 to March 2016. The mean age of patients was 23.6 yr (range, 12 to 45 yr). All patients completed a minimum follow-up of 5 yr. Outcomes were assessed by the 100-mm visual analogue scale (VAS), American Orthopedic Foot and Ankle Society score (AOFAS), and the postoperative complication rate. Results: Endoscopic examination revealed tibiotalar and subtalar hypertrophic synovitis in 14/32 and 13/32 patients, respectively. A small bony prominence encroached upon the FHL in 3/32 patients, 18/32 patients had FHL tenosynovitis, and the FHL tendon was constricted at its entry point into the tarsal tunnel requiring release of the flexor retinaculum in one patient. The mean AOFAS and the VAS scores significantly improved at final follow-up. The degree of improvement of AOFAS and the VAS scores was greater for the posterior ankle impingement group than the os trigonum fracture group. All patients experienced no major complications. Conclusions: Posterior endoscopic excision of a symptomatic os trigonum is safe, feasible, and has excellent results in patients with various sporting or occupational activities. The degree of improvement is greater for patients without os trigonum fracture. Level of Evidence: Level IV.

Using Google Trends to Identify Seasonal Variation in Foot and Ankle Pathology.

Google Trends proves to be a novel tool to ascertain the level of public interest in pathology and treatments. From anticipating nascent epidemics with data-driven prevention campaigns to identifying interest in cosmetic or bariatric surgery, Google Trends provides physicians real-time insight into the latest consumer trends. We used Google Trends to identify temporal trends and variation in the search volume index of four groups of keywords that assessed practitioner-nomenclature inquiries, in addition to podiatric-specific searches for pain, traumatic injury, and common podiatric pathology over a 10-year period. The Mann-Kendall trend test was used to determine a trend in the series, and the Wilcoxon signed-rank test was used to determine whether there was a significant difference between summer and winter season inquiries. Significance was set at P ≤ .05. The terms "podiatrist" and "foot doctor" experienced increasing Search Volume Index (SVI) and seasonal variation, whereas the terms "foot surgeon" and "podiatric surgeon" experienced no such increase. "Foot pain," "heel pain," "toe pain," and "ankle pain" experienced a significant increase in SVI, with "foot pain" maintaining the highest SVI at all times. Similar results were seen with the terms "foot fractures," "bunion," "ingrown toenail," and "heel spur." These terms all experienced statistically significant increasing trends; moreover, the SVI was significantly higher in the summer than in the winter for each of these terms. The results of this study show the utility in illustrating seasonal variation in Internet interest of pathologies today's podiatrist commonly encounters. By identifying the popularity and seasonal variation of practitioner- and pathology-specific search inquiries, resources can be allocated to effectively address current public inquiries. With this knowledge, providers can learn what podiatric-specific interests are trending in their local communities and market their practice accordingly throughout the year.

The perils of dressings: a cautionary tale of ischaemia.

A cohort of patients presented to Queen Victoria Hospital, UK, with iatrogenic toe ischaemia following application of a different, newly available post-procedure dressing with different properties to those usually used. This resulted in ischaemia with extensive skin and soft tissue damage, requiring debridement surgery and, in some cases, skin grafting. We aim to highlight the risk of morbidity from dressing application to the digits. This is a key learning skill for anyone who may either perform dressings or evaluate dressings on digits in the community and across multiple specialties in hospital. This article follows a thorough root cause analysis and addresses other possible causes of an acutely painful erythematous toe post-Zadek's procedure.

Identifying lower limb problems and the types of safety footwear worn in the Australian wine industry: a cross-sectional survey

BackgroundThe Australian wine industry is a valuable part of the wider Australian economy worth approximately A$45 billion annually and employs 163,790 people either full time or part time. Australian agricultural industries are amongst the nation’s most dangerous workplaces with joint, ligament, muscle and tendon injuries being commonplace along with wounds, lacerations and musculoskeletal diseases. It is therefore important to try and minimise the risk of injuries to workers. The aims of this study were to (1) identify whether lower limb problems occur in the Australian wine industry and (2) identify the types of safety footwear worn.MethodsParticipants were recruited from the Australian wine industry. The study was a cross-sectional anonymous survey of 82 questions with n = 207 respondents. Questions related to job role performed, types of lower limb problems experienced, level of pain, restriction of activities, types of footwear worn, general health and physical health.ResultsThe main working roles were winery (73.4%), vineyard (52.2%), laboratory (39.6%), cellar door (32.4%) and office (8.2%), with 63.3% of participants working in more than one role. Lower back pain was the most commonly reported problem at 56% followed by foot pain (36.7%), knee pain (24.6%), leg pain (21.3%), ankle pain (17.9%), hip pain (15.5%), toe pain (13%) and heel pain (11.1%). The most popular footwear used by participants were elastic sided safety boots, followed by high cut lace up safety boots with side zip. Overall, although the pain experienced was moderate, it did not impact the workers ability to perform their duties and the majority self-reported as being in very good general and physical health.ConclusionTo date no data have been published on the types of lower limb problems or the types of safety footwear worn in the Australian wine industry. This study is the first to demonstrate that elastic sided safety boots were the most popular amongst respondents and that lower limb problems occur with workers. Therefore, further research into the safety footwear used in the Australian wine industry is needed to better support workers health while working in their varied roles and conditions.

A Minimally-Invasive, Simple, Rapid, and Effective Surgical Technique for the Treatment of Ingrown Toenails: A Reminder of the Original Winograd Procedure.

(1) Background: Ingrown toenail is a common disorder of the toe that induces severe toe pain and limits daily activities. The Winograd method, the most widely used operative modality for ingrown toenails, has been modified over years to include wedge resection of the nail fold and complete ablation of the germinal matrix. We evaluated the outcomes of original Winograd procedure without wedge resection with electrocautery-aided matrixectomy. (2) Methods: We retrospectively analyzed the outcomes of patients who underwent surgery for ingrown toenails at a university hospital for two years from November 2015 to October 2017. Surgery was performed in 76 feet with a mean operation time of 9.34 min. (3) Results: The minimal interval from surgery to return to regular activities was 13.26 (range 7 to 22) days. Recurrence and postoperative wound infections were found in 3 (3.95%) and 2 (2.63%) patients, respectively. Evaluation of patient satisfaction at one-year follow-up showed that 40 (52.63%) patients were very satisfied, 33 (43.42%) were satisfied, 3 (3.95%) were dissatisfied, and none of them were very dissatisfied. The average follow-up duration was 14.66 (range 12 to 25) months. (4) Conclusions: Therefore, it is believed that this less-invasive and simple procedure could be easily performed by clinicians, with satisfactory patient outcomes.

Successful Treatment of Covid-19 Associated Cytokine Release Syndrome with Colchicine. A Case Report and Review of Literature

ABSTRACT We describe the case of a 42 year old, healthy patient with Covid-19 who despite improvement in his respiratory symptoms developed a mild to moderate cytokine release syndrome (CRS) and an associated monoarticular gout flare. Since the patient refused admission to the hospital and had stable vital signs, we chose to treat him with a safe anti-inflammatory and non-immunosuppressive therapy. To hit two birds with one stone, we considered colchicine, as it has systemic anti-inflammatory effects and is also effective in gout flare. Unexpectedly, 48 hours after treatment, not only did his ongoing fever and toe pain disappear, he also had significant improvements in his general state of health and all his inflammatory markers including fibrinogen, ferritin, D-dimer, and IL-6 levels normalized. To our knowledge, the use of colchicine in Covid-19 and CRS has not been reported. This observation merits the consideration of colchicine as a safe, inexpensive and oral medication for the treatment of mild to moderate CRS in Covid-19 patients. More importantly, in Covid-19 patients with early lung involvement colchicine may be an appropriate candidate to prevent CRS in adjunction with routine antiviral agents. Indeed, multicenter, randomized controlled studies are required to evaluate the benefits of this therapy.